Does Size Really Matter? Incidence of Periprosthetic Fractures After Femoral Osteotomy in Patients With Cerebral Palsy.

Objective: Of children, 30% to 35% with cerebral palsy (CP) develop hip subluxation or dislocation and often require reconstructive hip surgery, including varus derotation osteotomy (VDRO). A recent literature review identified postoperative fractures as the most common complication (9.4%) of VDROs.

Update on the reliability of gait analysis interpretation in cerebral palsy: Inter-institution agreement.

Background: Studies have shown good reliability for gait analysis interpretation among surgeons from the same institution. However, reliability among surgeons from different institutions remains to be determined.

Research Question: Is gait analysis interpretation by surgeons from different institutions as reliable as it is for surgeons from the same institution?

Methods: Gait analysis data for 67 patients with cerebral palsy (CP) were reviewed prospectively by two orthopedic surgeons from different institutions in the same state, each with > 10 years' experience interpreting gait analysis data.

Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy.

Background: Anterior distal femoral hemiepiphysiodesis (ADFH) is a surgical treatment choice to correct flexed knee gait and fixed knee flexion deformities in children with cerebral palsy who are skeletally immature. Increased anterior pelvic tilt has been reported after surgeries that correct knee flexion deformities, including hamstring lengthening (HSL) and distal femoral extension osteotomies, but anterior pelvic tilt has not been studied after ADFH. We hypothesized that anterior pelvic tilt would increase after ADFH, especially when combined with HSL, and it would correlate with the change in minimum knee flexion in stance and dynamic hamstring lengths.

Predictors of Changes in Pelvic Rotation after Surgery with or without Femoral Derotational Osteotomy in Ambulatory Children with Cerebral Palsy.

Asymmetry of pelvic rotation affects function. However, predicting the post-operative changes in pelvic rotation is difficult as the root causes are complex and likely multifactorial. This retrospective study explored potential predictors of the changes in pelvic rotation after surgery with or without femoral derotational osteotomy (FDRO) in ambulatory children with cerebral palsy (CP).

Persistent increase in anterior pelvic tilt after hamstring lengthening in children with cerebral palsy.

Background: Hamstring lengthening has traditionally been the surgical treatment of choice to correct flexed knee gait in children with cerebral palsy (CP). Improved passive knee extension and knee extension during gait are reported post hamstring lengthening, but concurrent increased anterior pelvic tilt also occurs.

Research Question: Does anterior pelvic tilt increase after hamstring lengthening in children with CP both in the short-term and mid-term, and what predicts increased post-operative anterior pelvic tilt?

Methods: 44 participants were included (age 7.

Gait Analysis Characteristics in Relapsed Clubfoot.

Background: Relapse rates of clubfoot deformity after initial correction range between 19% and 68% regardless of treatment approach. Most studies focus on relapse before age 4. Little research has focused on late clubfoot relapse.

The Effects of Prolonged Vibrotactile EMG-Based Biofeedback on Ankle Joint Range of Motion During Gait in Children with Spastic Cerebral Palsy: A Case Series.

Aims: The objective of this case series was to examine the feasibility of vibrotactile EMG-based biofeedback (BF) as a home-based intervention tool to enhance sensory information during everyday motor activities and to explore its effectiveness to induce changes in active ankle range of motion during gait in children with spastic cerebral palsy (CP).

Methods: Ten children ages 6 to 13 years with spastic CP were recruited. Participants wore two EMG-based vibro-tactile BF devices for at least 4 hours per day for 1-month on the ankle and knee joints muscles.

Cost savings for single event multilevel surgery in comparison to sequential surgery in ambulatory children with cerebral palsy.

Background: The purpose of this study was to determine the differences in billable provider charges between single event multilevel surgery (SEMLS) based on comprehensive gait analysis and a staged surgical approach (SSA) without comprehensive gait analysis for the orthopedic treatment of ambulatory children with cerebral palsy (CP).

Methods: The charges associated with nine common orthopedic surgical combinations (both unilateral and bilateral, soft tissue or soft tissue plus bony) for children with CP were determined and compared between SEMLS and SSA. The charges included surgical, anesthesia, operating room, recovery room, hospital stay, physical therapy, and, for SEMLS only, comprehensive computerized gait analysis.

Variation in Functional Mobility Within Gross Motor Function Classification System Levels.

Background And Objective: Variation in walking performance within Gross Motor Function Classification System (GMFCS) levels for patients with cerebral palsy (CP) is often unrecognized. The Functional Mobility Scale (FMS) rates mobility at household, school, and community distances. This study evaluated the variability of walking performance within GMFCS levels as measured by the FMS.

Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy.

Background: Medial calcaneal sliding (CS) osteotomy and lateral column lengthening (LCL) are often performed to relieve pain and improve transverse plane alignment and gait stability for children with cerebral palsy (CP) and valgus foot deformities. The purpose of this study was to examine the effectiveness of these procedures in this population.

Methods: Retrospective medical record review (including 3D gait analysis data) of patients with CP who underwent LCL (26 subjects, 46 limbs) or CS (46 subjects, 73 limbs).

Quantitative Computed Tomography Assessment of Bone Deficits in Ambulatory Children and Adolescents with Spina Bifida: Importance of Puberty.

Pathologic fractures of the femur and tibia are common in youth with spina bifida (SB). These fractures may be associated with deficient bone accrual due to decreased ambulation and skeletal loading. This prospective cohort study used quantitative computed tomography (QCT) to assess three-dimensional (3D) bone properties in children and adolescents with SB.

Anterior distal femoral hemiepiphysiodesis with and without patellar tendon shortening for fixed knee flexion contractures in children with cerebral palsy.

Purpose: Surgery is often required for fixed knee flexion contractures in patients with neuromuscular conditions. Anterior distal femoral hemiepiphysiodesis (ADFH) is an alternative to distal femoral extension osteotomy (DFEO) in skeletally immature patients. ADFH is typically not accompanied by patellar tendon shortening surgery (PTS).

Clinical efficacy of instrumented gait analysis: Systematic review 2020 update.

Background: This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA).

Research Question: What is the current evidence base pertaining to the clinical efficacy of 3DGA?

Methods: We identified English language articles published from September 2009 to October 2019 reporting primary research that used typical motion analysis laboratory methods to study human walking. Five gait laboratory experts classified articles according to the highest type of efficacy they addressed: type 1 (technical), 2 (diagnostic accuracy), 2b (outcome prediction), 3-4 (diagnostic thinking and treatment), 5 (patient outcome), 6 (societal).

Relationships among classifications of impairment and measures of ambulatory function for children with spina bifida.

Purpose: To examine associations between neurosegmental and functional level classifications in children with Spina Bifida, and determine which classification best reflects daily walking activity.

Materials And Methods: A prospective correlational study was conducted. Children with Spina Bifida were given ratings for lesion level [X-ray and International Myelodysplasia Study Group (IMSG) level determined by muscle strength] and functional level [Hoffer ambulatory level and Dias functional classification of myelomeningocele (FCM), Functional Mobility Scale (FMS)].

Causes of out-toeing gait in children with cerebral palsy.

Background: Out-toeing is common in children with cerebral palsy (CP), contributing to lever arm dysfunction and functional limitations. It is important to determine the cause(s) of out-toeing prior to treatment, whether surgical or non-surgical.

Research Questions: What are the contributors to out-toeing in children with CP and do they differ between children with bilateral and unilateral involvement?

Methods: The causes of out-toeing gait were determined retrospectively, with the use of computerized gait analysis, in 261 children with cerebral palsy (344 sides).

Rectus Femoris Transfer Surgery Worsens Crouch Gait in Children With Cerebral Palsy at GMFCS Levels III and IV.

Background: Previous study has shown that children with cerebral palsy (CP) functioning at Gross Motor Function Classification System (GMFCS) levels III and IV do not benefit from distal rectus femoris transfer (DRFT) due to lack of improvement in stance knee extension. The fate of knees in such subjects who do not undergo DRFT is unknown. The purpose of this study was to compare knee kinematic outcomes in patients with CP and stiff knee gait who underwent single-event multilevel surgery with and without DRFT.

Pre-operative hamstring length and velocity do not explain the reduced effectiveness of repeat hamstring lengthening in children with cerebral palsy and crouch gait.

Background: Hamstring lengthening surgery (HSL) is often performed to correct crouch gait in patients with cerebral palsy (CP). However, crouch can recur over time, and repeat HSL may be ineffective. One possible reason is that the hamstrings in repeat HSL patients are neither short nor lengthening slowly and would therefore not benefit from HSL.

Prevalence of specific gait abnormalities in children with cerebral palsy revisited: influence of age, prior surgery, and Gross Motor Function Classification System level.

Aim: To examine the impact of age, surgery, and Gross Motor Function Classification System (GMFCS) level on the prevalence of gait problems in children with cerebral palsy (CP).

Method: Gait analysis records were retrospectively reviewed for ambulatory patients with CP. Gait abnormalities were identified using physical exam and kinematic data.

Anterior Percutaneous Hemiepiphysiodesis of the Distal Aspect of the Femur: A New Technique: A Case Report.

Case: Anterior distal femoral hemiepiphysiodesis for knee flexion deformity in children is typically done using staples or plate-and-screw constructs. Staple migration and postoperative knee pain are common complications associated with these procedures. The authors describe a new technique of percutaneous epiphysiodesis using transphyseal screws (PETS) for anterior hemiepiphysiodesis of the distal aspect of the femur that was used to treat recurrent knee flexion deformity in a child with cerebral palsy who had recurrent crouch gait after hamstring lengthening.

Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy.

Purpose: To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy.

Methods: A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions.